共享决策和患者决策辅助工具是否认真对待患者的偏好?
Jack Dowie1,2, Mette Kjer Kaltoft2, Vije Kumar Rajput1,3
1London School of Hygiene and Tropical Medicine, London, UK).
Studies in health technology and informatics
|May 24, 2024
概括
大多数心房 (AF) 临床指南推患者决策辅助器用于共享决策. 然而,对10种工具的审查发现,很少有有效地纳入患者的偏好,阻碍了个性化护理. 这限制了最佳治疗决策.
科学领域:
- 医疗信息学 医疗信息学
- 健康决策科学 医疗科学
- 临床决策支持 临床决策支持
背景情况:
- 对心房 (AF) 管理的临床指南强调了患者决策辅助器 (PDA) 在共享决策 (SDM) 中的重要性.
- 有效的PDA应该支持患者做出与他们的个人价值观和偏好一致的知情选择.
- 现有的PDA通常在没有明确的框架来将患者偏好纳入决策过程的情况下进行评估.
研究的目的:
- 评估目前对心房的临床决策支持工具在多大程度上包含了患者的偏好.
- 确定现有工具在患者偏好的形成,提取和处理方面存在的局限性.
- 分析阻碍患者偏好与个人化证据在决策支持中的整合的理论基础.
主要方法:
- 对10种临床决策支持工具的系统检查,这些工具与房动的评估和管理有关.
- 分析工具特征,重点关注整个决策过程中的患者偏好.
- 对用于 (或不用于) 偏好集成的本体学和分析框架的理论分析.
主要成果:
- 经过审查的绝大多数决策支持工具未能充分参与患者的偏好.
- 只有两个工具证明了对偏好形成,诱导和处理个性化决策的强有力的方法.
- 这种失败归因于不愿意将偏好概念化为可测量的数量,并将它们与证据分析整合起来.
结论:
- 目前用于心房的临床决策支持工具往往不足以支持共享决策,因为忽视了患者的偏好.
- 需要理论和分析方面的进步,以便更好地将患者的偏好纳入决策支持框架.
- 开发能够透明地将个性化证据与患者偏好整合在一起的工具对于实现最佳,个性化的AF管理至关重要.
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